纤维喉镜吞咽功能评定量表的信度和效度研究

关键词：喉镜吞咽功能评定  吞咽障碍  信度  效度

Keywords:laryngoscopy swallowing function evaluation  dysphagia  reliability  validity

摘要：

      摘要 目的：针对编制的喉镜吞咽功能评定量表（fiberoptic endoscopic evaluation of swallowing， FEES）进行信度和效度研究，为本量表的临床使用提供试验基础。 方法：采用信度和效度检验的方法，对56例吞咽障碍患者的FEES视频样本进行编制量表的评估，完成组内、组间、内部一致性信度的比较，并与视频透视吞咽检查（VFSS）视频下的渗漏误吸量表（PAS）、FEES下的YALE量表相应参数进行关联度分析，同时进行内容效度及标准效度的检验。 结果：本研究将条目划分为感知觉功能、运动功能及进食功能评定三个维度，共纳入11项评估项目，合计43分。FEES量表在绝大多数条目中具有较好的评定者间信度（P>0.05）、较高的组内信度（r>0.65，P<0.05），且内部一致性信度较高，Cronbach's α系数最高条目为0.778（P<0.001），最低条目为0.700（P<0.001），各项条目及总分>0.7。在效度方面，该量表中的10项条目I-CVI>0.78，K*>0.74，提示条目内容效度优秀。且渗透误吸与PAS、YALE量表存在校标关联（r>0.8），因此具有较好的标准效度。 结论：本研究编制的FEES量表具有良好的信效度，未来在大样本、多中心验证的基础上，可在临床进一步应用。

Abstract:

      Abstract Objective： To develop fiberoptic endoscopic evaluation of swallowing （FEES） scale to provide systematic indexes for the diagnosis and evaluation of swallowing disorders under FEES. It provides reference for the formulation of rehabilitation strategy. Method： The reliability and validity test was conducted using used samples from 56 patients with dysphagia. The FEES scale was used to assess swallowing function. Intra-rater, inter-rater, and internal consistency reliability were analyzed. Correlations between FEES scale scores and corresponding parameters of the penetration-aspiration scale(PAS) from video fluoroscopic swallowing studies (VFSS) and the Yale Pharyngeal Residue Severity Rating Scale under FEES were examined. Content validity and criterion validity were also evaluated. Result： The scale comprises 11 items across three dimensions： sensory and perceptual function， motor function and eating function， with a total of 43 points. The FEES scale has good inter-rater reliability （P>0.05）， high intra-group reliability （r>0.65，P<0.05）， and high internal consistency reliability among most of the items. with the highest Cronbach's α coefficient being 0.778 （P<0.001）， the lowest being 0.700 （P<0.001）， and the total score of each item was >0.7. In terms of validity， the I-CVI of 10 items in this scale is greater than 0.78， and K* is greater than 0.74， indicating that these items have excellent content validity. The correlation between aspiration and PAS and YALE scale calibration （r>0.8） is very good， so it has good standard validity. Conclusion： The FEES scale demonstrated good reliability and validity. With further validation in larger, multicenter studies, it holds promise for widespread clinical use.